HomeMy WebLinkAboutMortgage_Rosa 4 n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE .,�
-} v ��,= �� Township Year
� FOR DEDUCTION FROM ASSESSED VALUATION
i= it 1 State Form 43709
S r;� Prescri bed by Departm ent - _-
of Local Government Finance % '
INSTRUCTIONS: ,UN Fi ' Mark
To be filed in person or by mail. _ I i1, Fop filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is so ,• A K
Must be filed or postmarked with the County Auditor or County Recorder of the county whe - 1: S� .r It PVC County Auditor
located on or before January 5 of the immediately succeeding calendar year. ��(��p1 ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coud Y or of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or ntract buyer-see restrictions oo/ry (,vveersee side
Tax,'istrict
0-410-11C0-0-.mber/l" egal descri n Record number Page number
lain ? ‘,-log-0$. L5Di .. 6°/.aya -oag 0o/( ao9�
Assessed value of real p'r�P�(Y/as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness u id as of Is the applicant the le
March 1,current year March 1, ent year /� date of application legal or equitable owner?
5 7 Y, 9 '❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
al Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller j0 —
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ��77,,��
. • Drawer jIND.••' c(/l&
Name of assignee or other owner or holder of mortgage •••••••
Address of assignee(number and street,city,state,and ZIP code) '' Cat I-(� jar 0 �v /
.......... ..........
Does applicant own property in any If yes,what county? What Taxing District? i ?Auction
other county
in Indiana? ❑Yes ❑No current yeaR u 1 e ,
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR .
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
•
f its - • - t L. ' t 4 1 • - at_ I
I ull resident address of apprcan a mber an.street,city,state, -nd ZIP code)
j'>o I` G't\Wilk r
Person authorized by duly exe le.l ov- ofAttomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.